Lapointe-Shaw Lauren, Tran Kim L, Coyte Peter C, Hancock-Howard Rebecca L, Powis Jeff, Poutanen Susan M, Hota Susy
Department of Medicine, University of Toronto, Toronto, Canada.
Department of Medicine, University Health Network, Toronto, Canada.
PLoS One. 2016 Feb 22;11(2):e0149521. doi: 10.1371/journal.pone.0149521. eCollection 2016.
To assess the cost-effectiveness of six treatment strategies for patients diagnosed with recurrent Clostridium difficile infection (CDI) in Canada: 1. oral metronidazole; 2. oral vancomycin; 3.oral fidaxomicin; 4. fecal transplantation by enema; 5. fecal transplantation by nasogastric tube; and 6. fecal transplantation by colonoscopy.
Public insurer for all hospital and physician services.
Ontario, Canada.
A decision analytic model was used to model costs and lifetime health effects of each strategy for a typical patient experiencing up to three recurrences, over 18 weeks. Recurrence data and utilities were obtained from published sources. Cost data was obtained from published sources and hospitals in Toronto, Canada. The willingness-to-pay threshold was $50,000/QALY gained.
Fecal transplantation by colonoscopy dominated all other strategies in the base case, as it was less costly and more effective than all alternatives. After accounting for uncertainty in all model parameters, there was an 87% probability that fecal transplantation by colonoscopy was the most beneficial strategy. If colonoscopy was not available, fecal transplantation by enema was cost-effective at $1,708 per QALY gained, compared to metronidazole. In addition, fecal transplantation by enema was the preferred strategy if the probability of recurrence following this strategy was below 8.7%. If fecal transplantation by any means was unavailable, fidaxomicin was cost-effective at an additional cost of $25,968 per QALY gained, compared to metronidazole.
Fecal transplantation by colonoscopy (or enema, if colonoscopy is unavailable) is cost-effective for treating recurrent CDI in Canada. Where fecal transplantation is not available, fidaxomicin is also cost-effective.
评估加拿大针对确诊为复发性艰难梭菌感染（CDI）患者的六种治疗策略的成本效益：1. 口服甲硝唑；2. 口服万古霉素；3. 口服非达霉素；4. 灌肠粪菌移植；5. 鼻胃管粪菌移植；6. 结肠镜粪菌移植。
涵盖所有医院和医生服务的公共保险公司。
加拿大安大略省。
采用决策分析模型，对一名典型患者在18周内最多经历三次复发的每种策略的成本和终身健康影响进行建模。复发数据和效用值来自已发表的资料。成本数据来自已发表的资料以及加拿大多伦多的医院。支付意愿阈值为每获得一个质量调整生命年（QALY）50,000美元。
在基础病例中，结肠镜粪菌移植优于所有其他策略，因为它比所有替代方案成本更低且更有效。在考虑所有模型参数的不确定性后，结肠镜粪菌移植有87%的概率是最有益的策略。如果无法进行结肠镜检查，灌肠粪菌移植每获得一个QALY的成本效益为1,708美元，与甲硝唑相比具有成本效益。此外，如果该策略后的复发概率低于8.7%，灌肠粪菌移植是首选策略。如果无法采用任何方式进行粪菌移植，与甲硝唑相比，非达霉素每获得一个QALY的额外成本为25,968美元，具有成本效益。
在加拿大，结肠镜粪菌移植（如果无法进行结肠镜检查则采用灌肠粪菌移植）治疗复发性CDI具有成本效益。在无法进行粪菌移植的情况下，非达霉素也具有成本效益。
